Scoliosis Correction Surgery

Divisi Neurospine, Subdepartment Bedah Saraf, Department Bedah,

Fakultas Kedokteran Universitas Udayana, RSUP Prof IGNG Ngoerah, Bali,
Indonesia
01 Review
02 Case
description
03 Possible surgical
approach
01 Review
Goals of surgery in Spinal Deformity:

1 Restoration of coronal and sagittal spinal alignment

2 Decompression of the neural element

Goals of surgical correction:

1 Sagittal vertical axis less than 50 mm

2 Pelvic tilt less than 20 degree

01 Review
01 Review
Surgical principle in spinal deformitiy:

1 Proximal and distal fusion segments

2 Correction of sagittal deformity

3 Correction of coronal deformity

01 Review

1 Proximal and distal fusion segments

Instrumentation should not terminate at or near the apical vertebra in the sagittal or
coronal plane.
Instrumentation should extend to a neutral vertebra to balance the fixation
construct within the deformity.
The neutral vertebra is the vertebra associated with little or no angulation or
rotation at the rostral and caudal disc spaces of the curve
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2 Correction of sagittal deformity

Sagittal balance must be obtained before actual fixation of spinal segments to the
final contoured rods. Such manoeuvres generally involve posterior osteotomies and
anterior interbody work.

Posterior osteotomies involve resecting the posterior elements of the spine, namely
the medial facet joints and the distal pars interarticularis, followed by posterior
compression, which allows posterior shortening and increases lordosis.
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Ponte osteotomy
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Pedicle subtraction
osteotomy
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3 Correction of coronal deformity

The adult spine does not reduce easily to a contoured rod because of its inherent
stiffness and poor bone quality.

Coronal deformity is approached using the same techniques discussed earlier to

obtain sagittal balance.
Quadrangular pedicle subtraction osteotomy can be used with one side more
aggressively osteotomized than the other, allowing restoration of the Cobb angle.
02 Case description
Pasien datang dengan keluhan nyeri pada pinggang yang dirasakan mulai memberat sejak 2 tahun terakhir terutama saat pasien
berjalan. selain itu pasien juga mengeluh tulang punggung tampak miring ke kiri. hal tersebut sudah dirasakan sejak lebih dari 10th
yang lalu, namun sejak 2 tahun terakhir dirasa makin memberat hingga mulai timbul rasa nyeri dan mengganggu aktifitas pasien.
riwayat trauma (-)
Pemeriksaan Lain
Patrick : -/-
Status Neurologis
Anti-Patrick : -/-
Motorik
Laseque : -/-
Tenaga : 55555/55555 // 55555/55555
Tonus : N/N // N/N
Trofik : N/N // N/N
R. Fisiologis : +2/+2 // +2/+2
R. Patologis : -/- // -/-
Sensorik
Pinprick : dbn
Lighttouch : dbn
Proprioseptif : +/+ // +/+
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03 Possible Surgical
Approach
T8
T9

T10
Screw on stable zone of Harrington and T11

junctional Th-L T12

L1
Screw on convex side and placement of
long segment rod, correction (suggested) L2

L3

L4

Screw on concave side and placement of L5

long segment rod (less necessary) S1

Thoracal  Extrapedicular screw

Lumbal  Pedicular screw
Sacral  SI screw
03 Possible Surgical
Approach
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